Minister says quality of public healthcare must go up, and cost of private healthcare come down, if scheme is to work.

Health Budget speech by Dr Aaron Motsoaledi, MP, Minister of Health, National Assembly

15 May 2013

Honourable Speaker
My colleague the Deputy Minister of Health
MECs for Health present
The Chairperson and members of the Health Portfolio Committee
Honourable Members of Parliament
Invited Guests
Ladies and Gentlemen

Honourable Speaker, it is now well documented and generally understood that South Africa faces a quadruple burden of disease. Many other countries are faced only with a double burden.

These four are:

1. A very high prevalence of HIV and AIDS which has now entered into a synergistic relationship with TB;
2. Maternal and Child morbidity and mortality;
3. Exploding prevalence of non-communicable diseases mostly driven by risk factors related to life-style; and
4. Violence, injuries and trauma.

These four colliding epidemics resulted in death notification doubling between 1998 and 2008 to 700 000 per year as noted by the National Planning Commission. Life expectancy in the country also took a knock and declined to worrying levels.

We had to respond to these very urgently and very decisively.

In addition to our Ten Point Programme, the Department of Health signed the Negotiated Service Delivery Agreement with the President. We committed to four (4) objectives which we called outputs during this term of government.

These are:

1. Increasing Life Expectancy;
2. Reducing maternal and child mortality;
3. Reducing the burden of disease from HIV and AIDS and TB;
4. Improving the effectiveness of the health system

After going into a deep analysis of the problems, it became clear that unless we deal decisively with HIV and AIDS and TB, it would be foolhardy to believe that we could ever decrease the high levels of mortality and morbidity in our country. Hence our plans had to have a very strong element of a desire, commitment and passion as far as HIV/AIDS and TB are concerned.

This did not mean that the other epidemics were less important, it simply emphasised that the central driver of morbidity and mortality in South Africa was largely HIV and AIDS and TB.

Honourable Speaker, we responded comprehensively through well designed plans to deal with HIV and AIDS and TB, and the implementation of these plans was well executed.

Among others Honourable Speaker, we increased the health facilities providing antiretrovirals (ARVs) from only 490 in February 2010 to 3 540 to date. The number of nurses trained and certified to initiate ARV treatment in the absence of a doctor were increased from only 250 in February 2010 to 23 000 nurses to date. This programme is called NIMART or Nurse Initiated Management of Antiretroviral Therapy. NIMART made it possible to increase the number of people on treatment from 923 000 in February 2010 to 1,9 million to date – that is actually doubling the number on treatment.

I wish to take this opportunity to thank all the health workers for this sterling performance – especially the nurses without whom this numbers would have been impossible to achieve.

Very recently Honourable Speaker, we have introduced the ground breaking fixed dose combination (FDC) therapy which made it necessary to train 7 000 health workers for smooth implementation.

Another very important windfall from these FDCs is that by February 2010, it used to cost us R313.99 per patient per month to provide ARVs. With the FDCs, it is now costing us only R89,37 per patient per month. We are now able to treat many more people per month with the amount of money that we used to treat one person with in 2009.

The results we achieved from these endeavours are very sweet indeed.

By the end of last year, researchers, local and international started reporting a dramatic increase in life expectancy in our country. They also reported a decline in under five mortality and maternal mortality ratio. Our biggest challenge is the neonatal mortality rate. These researchers include our Medical Research Council’s Rapid Mortality Surveillance Report, the Lancet, and United Nations agencies like the UNAIDS.

All these researchers attributed the decline in mortality and the concomitant increase in life expectancy to our comprehensive response to the HIV epidemic, especially the ARV treatment programme.

The fact that we are testing large numbers of our people and large numbers are on treatment has brought much relief to individuals, families and communities.

As far as TB is concerned Honourable Speaker, we started in earnest on 24 March 2011 to introduce new programmes. We unveiled new strategies to combat TB.

(a) Firstly, we unveiled the GeneXpert technology. Honourable Speaker, the last time in the world that a new technology do diagnose TB was unveiled was more than fifty (50) years ago. The World had then thought we had defeated TB. We now know better. We are hence immensely relieved that a new, faster and very effective technology has now been unveiled by scientists commissioned to do so by the World Health Organisation’s Stop TB Partnerships.

Before GeneXpert technology, it used to take us a whole week to diagnose TB. Now it takes us only two (2) hours.

It used to take us three (3) months to conclude that a person has multi-drug resistant TB, now it takes us only two (2) hours to know that.

I am very proud that South Africa was the very first country on this continent to unveil the GeneXpert technology. Since its unveiling on 23 March 2013, we have distributed 242 GeneXpert units around the country. This 242 constitute 80% of all facilities we would like to cover. We had spent R117 million shared by the National Department of Health, the Global Fund and the Center for Disease Control in the USA to achieve this 80% coverage. We have conducted 1,3 million tests using this technology since 2011. This constitutes more than 50% of the total tests conducted in the whole world.

In five (5) months’ time, we will achieve 100% coverage of all the district hospitals with the GeneXpert technology. From there we will move to the big community health centers.

The biggest of these machines, that can diagnose forty-eight (48) patients at a time, the others can do only 4 or 16, are called GeneXpert 48. We only have two (2) in the whole country. We have placed one at the Ethekwini Municipality at Prince Mshiyeni Hospital. The second one is in the Cape Metro at Greenpoint National Health Laboratory Service (NHLS) laboratory.

We have done this because both Ethekwini and the Cape Metro are the most very heavily challenged cities as far as TB is concerned.

On World TB Day, on 24 March this year, you are aware that the Deputy President of the Republic unveiled a GeneXpert technology at Pollsmoor Prison, on behalf of all Correctional Services facilities. This was in response to a Constitutional Court ruling where an inmate took the government to court, and the State was held liable for inmates contracting TB in jail. Yes, it is now well established that the highest rate of TB in our country is in correctional service facilities. They too, will be supplied with GeneXpert units to screen all inmates on entry to facilities and also to screen them twice a year once they are inside.

We will also request for the names of those who are found by the GeneXpert to be having TB, from the Minister of Correctional Services in order to send health workers to their families so that the whole family of an inmate can be screened. One person with TB has a potential to infect 15 others in their life time.

Honourable Speaker, the second strategy we have adopted was to establish family teams. On our database, we have 405 000 families in South Africa who have a member diagnosed with TB. The family teams are visiting these families to screen all members within such a family.

About four (4) weeks ago, the Statistician-General went to Thabo Mofutsanyane Region to release StatsSA’s yearly figures on the cause of death. He released the 2010 figures and announced that TB was found to be the number one (1) killer in the country – not surprising given the synergistic relationship between TB and HIV and AIDS as I said earlier.

We are eagerly waiting for the 2011 and 2012 figures to see how effective our programmes have been. For now, we can report that in 2008 our TB cure rate was 67,5% but in 2012 it has improved to 75,9%. The target set by the World Health Organisation is 85% cure rate. We are steadily but surely moving in that direction. However Honourable Speaker, I have one very serious request to make. Having turned the corner should not be regarded as a signal for South Africans to be complacent. We still have a very long road to travel with HIV/AIDS and TB.

The National Development Plan has clearly indicated that by 2030, we must have a generation of under twenties (20) being free of HIV and AIDS and we must have a decrease in TB contact indices.

At the recent SANAC Plenary we have decided that the Presidency will we need to re-launch for us the HIV Counselling and Testing (HCT) Campaign in the country. This launch must happen at Gert Sibande District in Mpumalanga. It is now officially declared a district with the highest prevalence rate of HIV in the country.

I have a serious complaint Honourable Speaker, that since the campaign started, there is one extremely powerful place in this country were the HCT campaign was never launched. It is called the Parliament of the Republic of South Africa.

Please Honourable Speaker, may I humbly ask that you choose a date where we will come and publicly launch this campaign here in Parliament with you and the Chairperson of the National Council of Provinces (NCOP) taking the lead, followed by leaders of all political parties in this hallowed chambers. Then the provincial legislatures, District Councils and local councils will follow suite. I will then have the power and courage to ask churches, schools and all other centers of our civil life to choose their own days to do so.

I promise to supply a GeneXpert unit as well as a mobile XR unit for the benefit of Members in this Parliament because you also will need to be screened for TB as well, on top of testing for HIV and AIDS.

Honourable Speaker, let me now deal with the intractable problems that the health care system is faced with. It is output number four, i.e the efficiency and effectiveness of the healthcare system in the country.

You are well aware Honourable Speaker, that our flagship programme to change the efficiency and the effectiveness of the healthcare system in this country is the NHI – the National Health Insurance system.

While South Africans have been throwing mud at each other about NHI, I need to indicate that we need to stop wasting our time. NHI has gone global. The World Health Organisation (WHO), the United Nations (UN), the World Bank, prestigious institutions of high learning such as the Harvard University, have recently entered the fray in support of NHI and in giving well researched guidance to countries on how to get about to implement NHI – not to debate whether it is needed or not. The world has gone far beyond that stage.

Recently the World Bank and Harvard University organised a workshop of all Ministers of Finance to guide them on how their treasuries can support NHI for the benefit of economic growth.

It is of course not called NHI in every country. The World Health Organisation and all the UN agencies are calling the generic term, Universal Health Coverage. We will stick to the term NHI.

The Prestigious British medical journal, the Lancet has launched a series since late last year to allow academics, health activists and researchers to write articles to guide countries about this concept of Universal Health Coverage.

It doesn’t matter what you call it – the concept is the same i.e every citizen has a right to access to good quality, affordable health care, and that the access should not be determined by the socio-economic condition of the individual.

Hence whether you call it NHI as we are doing here in South Africa, or NHS as they do in England, or Seguro Popular as they say in Mexico or Obama Care as the Americans call theirs, the concept is the same.

In the editorial of Vol. 380 of September 8, 2012 of the Lancet it states that “certain concepts resonate so naturally with the innate sense of dignity and justice within the hearts of men and women that they seem an insuppressible right. That healthcare should be accessible to all is surely one such concept. Yet in the past, this notion has struggled against barriers of self-interest and poor understanding”.

The editorial goes further to say: Building on several previous Lancet Series that have examined health systems in Mexico, China, India, South East Asia, Brazil and Japan, today we try to challenge those barriers with a collection of papers that make the ethical political, economic and health arguments in favour of Universal Health Coverage and will be presented in New York on September 26 to coincide with the United Nations General Assembly. The series was facilitated by the Rockefeller Foundation and edited by David de Ferranti of the Results for Development Institute in Washington DC. The conclusions support the World Health Organisation (WHO) Director-General Dr Margaret Chan’s assertion that Universal Health Coverage is the single most powerful concept that public health has to offer”.

Honourable Speaker, the editorial goes on to say and I quote again: “Universal Health Coverage, like any other health system, must be accountable for the quality of its outcome and the compassion of its care. The emphasis should be on responsiveness to service users, rather than on profit for share holders”.

It is very clear Honourable Speaker and Honourable Members that the whole world, and not only our country is gearing to rid itself of archaic healthcare financing systems that cater for the privileged few, and punishes the poor, in favour of healthcare systems that will benefit all – and all citizens of a country.

This assertion, led to another article in the Lancet series I have just mentioned. It argues that Universal Health Coverage is poised to be a third global health transition.

The argument is based on the fact that since humanity came into being, there have been only two great transitions in health on this planet.

The first was the demographic transition that began in the late 18th century and changed the planet in the 20th century through public health improvements, including basic sewerage and sanitation, which helped to reduce premature deaths greatly.

The second transition was the epidemiological transition that began in the 20th century and eventually reached even the most challenged countries in the 21st century.

Communicable diseases, from smallpox to poliomyelitis were vanquished or controlled on a scale never imagined, opening the way for contemporary action to tackle non-communicable diseases.

Now a third great transition seems to be sweeping the globe, changing how healthcare is financed and how health systems are organised. For a along time, getting healthcare has meant first paying a fee to the provider – a practice that effectively burdens sick and needy people, that has meant choosing between going without needed services or facing financial ruin”.

Honourable Speaker in implementing NHI or Universal Health Coverage countries are clearly going to pay different prices for different durations in time, depending on internal objective factors and dynamics within each country. Hence a country like Qatar, is going to implement NHI starting in July this year and completing in December next year. Here in South Africa, we have given ourselves 14 years to achieve the same.

Unlike Qatar, there are two main prices we are going to have to pay for successful implementation of NHI.

The first price is that the quality of services in the public health system has to drastically undergo a metamorphosis – the quality simply has to improve and there is no running away from that.

The second price is that the cost of private healthcare has to drastically reduce. We need to firmly regulate the prices in private healthcare.

Honourable Members, as a Department of Health, we strongly welcome last week’s announcement by the Minister of Economic Development, Honourable Minister Patel, that through the amended Competition Act, the Competition Commission will launch a public market inquiry into the cost of private healthcare. We as a Department are fully behind Minister Patel and the Competition Commission on this one and we are ready to engage and offer all evidence we have at our disposal. We are eagerly waiting for the Commission to call us! For those who don’t understand where this is coming from, I wish to refer you to our National Development Plan, Vision 2030 and I quote:

“A national health insurance system needs to be implemented in phases, complemented by a reduction in the relative cost of private medical care and supported by better human capacity and systems in the public health sector”.

As to how we are going to pay the first price I have mentioned earlier, i.e on the issue of quality in the public health system, we shall outline that in the White Paper that will be released soon. We did indeed take a very long time since the Green Paper was launched. There were lots of inputs and developments that needed our very careful attention and considerations.

We will be ready very soon.

It will be released with a clear plan on how NHI is to be implemented based on the two main prices which I said the country has to pay.

Because these are elaborate plans, it will not be possible at all to outline them here. They will be made available in due course. They will include the whole concept of non-negotiables in healthcare, the delegation of powers to CEOs who are being newly appointed and trained. This will also include abolishing the dreaded depot system of drug supply to allow CEOs to get medicines directly from suppliers.

But I wish to take this opportunity to emphasize over and over again, that the NHI will be based on a preventative and not a curative healthcare system.

I will then repeat in many more occasions to come that Primary Health Care, meaning prevention of diseases and promotion of health is going to be the heartbeat of NHI in South Africa.

We will drive this healthcare system according to the dictates of the National Planning Commission which clearly states that among the important things to be done, is to reduce the burden of disease, not to allow them to flourish and then try to run helter skelter in trying to cure them, with very limited facilities, both human and financial, which is the hallmark of public health systems on the African continent.

We wish to demonstrate with a few examples on what prevention of diseases and promotion of health can do to a country’s health system.

A report compiled by the Mail & Guardian’s newly established BHEKISISA health reporting center and published on Friday last week demonstrates one of the examples

It shows how four years ago, the Department of Health introduced two very new vaccines, Prevenor, to reduce the risk of children contracting Pneumonia, and Rotarix to prevent incidences of diarrhoea in children. Remember that diarrhoea was killing 25 South African children under the age of five (5) each day.

At the time of the inception of the two vaccines, National Institute of Communicable Diseases, the NICD, was tasked with the work of monitoring and evaluating the impact of these vaccines on hospitalisations in three South African hospitals – in Cape Town, KwaZulu-Natal and Gauteng.

The findings were that at Ngwelezele Hospital in Kwa-Zulu/Natal the under five mortality rate was three times higher than in Soweto. However, the Ngwelezene Hospital ward that deals specifically with diarrhoea i.e the gastrointestinal ward, has recently been closed down as a result of the introduction of this vaccine. Around 2006, this ward used to admit close to 1 000 children annually. It is now closed down – no more need!!

On average, in all these three sites there has been a 70% reduction in admission due to diarrhoeal diseases attributable to Rotavirus.

Seeing the successes that vaccines can bring Honourable Speaker, our next target is cancer of the cervix of the uterus. One of the biggest killers of women.

According to Prof Lynette Deny, and Dr Yasmin Adam of the Department of Obstetrics and Gynaecology at Groote Schuur Hospital and Chris Hani Baragwanath Hospital respectively, cervical cancer affect 6 000 South African women annually. 80% of them are African women.

Out of these 6 000 affected, between 3 000 and 3 500 die annually as a result of this cancer.

More than 50% of women affected are between 35 and 55 years of age. Only 20% are older than 65 years of age.

HIV positive women are five times more likely to get it than HIV negative women.

This cancer is caused by another dangerous virus – the human papilloma virus. The good news is that there is now a vaccine against this virus. The very bad news is that it is available in the private sector but the costs are prohibitive between R500 and R750 a dose (3 doses are needed for protection) – even in the private sector the uptake is very slow due to this prohibitive costs.

At the moment Honourable Speaker, to make these vaccines affordable, the Bill and Melinda Gates Foundation established GAVI (Gates Action for Vaccines and Immunisation) to help poor countries.

Unfortunately, South Africa does not qualify for GAVI prices which we are made to understand, are at only $4,00 per dose.

We are also aware that the PAHO (Pan American Health Organisation) has negotiated a price of $13,00 a dose for Latin American countries.

I am extremely happy to announce that in consultation with the Minister of Finance and the Minister of Basic Education, we have decided that we shall commence to administer the HPV vaccines as part of our School Health Programme as from February next year.

We will enter negotiations in our own right to also be given a fair deal in the interest of the lives of the women of this country.

We are advised by scientists that the vaccine is only fully effective before sexual activity commences.

For this reason, we shall administer it to all 9 year and 10 year old girls in Quintiles 1, 2, 3 and 4 schools.

This will cover 385 000 of the 9 and 10 year olds. We are not unduly discriminating against Quintile 5 schools. Children from poor families who find themselves for one reason or the other in Quintile 5 schools will also be covered.

I am calling for parents of all remaining learners in that category of schools, that since they can afford, for now they must try to acquire the vaccines themselves until we are able to cover all learners in the mentioned age bracket in all the schools. I am calling on all Medical Aid Schemes in the country to pay for these vaccines to help parents in the category of learners who will not be covered when we commence the programme. The benefits far outweigh all the costs. It costs up to R100 000 per patient in the public sector to treat each of the 6 000 cervical cancer patients.

I am scared to quote you the figures for the private sector treatment.

Honourable Speaker, this week, very bad news emerged from our health facilities about an entity called RWOPS – Remunerated Work Outside the Public Service – whereby doctors fully employed by the State conduct their own private work during certain hours. RWOPS is not illegal. It was passed by the Cabinet around 1994.

The only problem is that it is being abused by some unscrupulous individuals.

I must emphasise Honourable Speaker, the overwhelming number of doctors in the public service are very decent law abiding hard working citizens who are deeply committed to their patients.

It is only a few who are tarnishing the name of the profession. I am appealing that the events that unfolded over the media this week must not be misconstrued that most doctors are involved in this practice and start regarding all doctors as some form of criminals. I want to repeat, the majority are very ethical citizens who understand their calling.

The few individuals who are involved, are not only punishing patients, they are also destroying the medical training in the country because they leave medical students to their own devices. Even specialists in training are badly affected by being abandoned by people who are supposed to guide them in every step of their training.

I have already warned the private sector, who are benefitting from this bad practice, that in the long run, they also will suffer because the country will produce poorly trained doctors.

I have given this matter to the Deans of all our medical schools where this practice seems to be very rife, to discuss the matter and come up with recommendations which will be presented to all stakeholders in health. We will call a press conference to determine the way forward. But we can’t avoid criminal charges to those who have been caught red-handed because we have their names and know their activities.

We will also refer their names to the South African Revenue Service (SARS) to see if they are paying tax in the double income they are getting.

We are also appealing to the private sector who are hell-bent on attracting this public servants with lots and lots of perverse incentives. This is going to destroy everybody in the long run.

I wish to take this opportunity to thank the Deputy Minister, the Director-General and all managers in our Head Offices and facilities. Our health workers still remain our heroes and heroines despite a few who want to tarnish their good names. I wish to thank them for the sterling work performance done under very trying circumstances.

I thank you.

Issued by the Department of Health,

May 15 2013

http://www.politicsweb.co.za/politicsweb/view/politicsweb/en/page72308?oid=377010&sn=Marketingweb+detail&pid=90389

MBABANE, 16 May 2013 (IRIN)

It was an ambitious plan to circumcise the majority of men in Swaziland, an effort to reduce the risk of HIV transmission in a country with the world’s highest HIV prevalence. How could it have gone wrong?

“First they told me that circumcision will not really protect me against HIV. Then they tell me that I cannot have sex for some weeks or months after circumcision. I told them ‘fusaki’ [get out]!” Eric Dlamini, a 22-year-old law student, told IRIN.

These views are at the heart of the failure of the Accelerated Saturation Initiative (ASI) to achieve more than a fraction of its targeted goal, the circumcision of 80 percent of Swazi males between ages 15 and 49 within a year.

The programme, a partnership between the Ministry of Health and Social Welfare and the US-based Futures Group, was launched in 2010, and extended to 30 March 2012 when initial efforts showed a failure to achieve targeted results. But only about 20 percent – or 32,000 – of the targeted demographic were circumcised through the programme.

US$15.5 million was spent on the programme, or $484 per circumcised male.

“We do not believe [ASI] was a failure but an additional prevention measure that is contributing to the overall combination efforts to end the HIV/AIDS pandemic in the country,” US Embassy in Swaziland spokesperson Molly Sanchez Crowe told the local press.

Imposed from outside?

Male circumcision has been scientifically proven to reduce a man’s risk of contracting HIV through vaginal intercourse by as much as 60 percent. Follow-up studies have found that the effectiveness of male circumcision in HIV prevention is maintained for several years.

Government health officials, like Minister of Health Benedict Xaba and Khanya Mabuza, the acting director of the National Emergency Council on HIV and AIDS (NERCHA), have noted that ASI taught the country important lessons and left behind several clinics and other health infrastructure.

But a year after the programme ended, Swazi health officials are still trying to figure out what went wrong. Health workers, who spoke to IRIN on the condition of anonymity, pointed out that the programme was hastily implemented. They wondered why the short implementation time was not extended. Ending the programme, they fear, may suggest to international donors that the country is a hopeless cause.

“We have been struggling with HIV for 20 years, and we see programmes come and go. Some are fads… and some are not well thought out. The Swaziland programme came from the outside. The health ministry was willing to go along because there was money there. But it was imposed,” said Thandi Mduli, an HIV testing officer in Manzini.

Officials with health-oriented NGOs admitted to IRIN they are “terrified” of criticizing an initiative funded by the “mighty” US President’s Emergency Plan for AIDS Relief (PEPFAR) and involving the global population control NGO Population Services International (PSI).

The ASI programme was an attempt to duplicate in Swaziland the circumcision successes seen in Kenya and other countries, without apparently doing the pre-campaign ground work. Kenya has carried out an estimated 477,000 circumcisions since its programme started in 2008, according to the government.

In 2011, UNAIDS and PEPFAR launched a five-year plan to have more than 20 million men in 14 eastern and southern African countries undergo medical male circumcision by 2015.

Reasons for failure

“There were a lot of issues involving male circumcision that were not properly explained to Swazi men, so they rejected it and they talked to their friends, and word of mouth was negative instead of positive. This is the opposite of what a campaign like this needs to work,” said NERCHA’s Mabuza.

Other issues included unfamiliarity of the procedure. “When I heard I would still have to wear a condom, I said, ‘What is the point?’” said Samkelo Mduli, a university student.

A survey commissioned by the Futures Group in 2011 found that although there was a 91 percent awareness of circumcision, nationally, the largest barrier to circumcision was fear of pain. Other barriers included fear of something going wrong, and a general lack of understanding of the procedure.

Another reason for the rejection of circumcision was not anticipated by ASI promoters: belief in witchcraft, which is widespread in Swaziland. Criminals are known to seek “strengthening” potions made with human body parts. Killings associated with “ritual murder” routinely correspond with national elections. Victims, usually children or older people, are found with body parts missing. One attack made headlines in the Swazi press recently.

“That’s also what I wanted to know, and they wouldn’t tell me – what happens to my foreskin once it is cut off?” said Mduli.

Health Minister Xaba alluded to this when he told the Times of Swaziland, “Some men feared that the foreskin could end up in wrong hands, being used by some unscrupulous people for their ulterior motives.”

“This is embarrassing and nobody wants to talk about it,” said the programme director of a faith-based HIV/AIDS initiative in Manzini. “The circumcision initiative failed because of this arrogance on the part of its promoters. It would have been easy to be honest and explain to the Swazi men that their foreskins would be incinerated like all surgical refuse. But the promoters said, ‘Oh, no, we can’t talk about witchcraft. What will the donors say?’”

By SAFAIDS

http://safaids.net/content/circumcision-plans-go-awry-swaziland

Deputy President Kgalema Motlanthe at a plenary meeting of the South African National Aids Council in Secunda, Mpumalanga. Picture: GCIS

By Samuel Mungadze

A NATIONAL Strategic Plan for HIV, tuberculous (TB) and sexually transmitted infections has been adopted on Friday, during South African National Aids Council (Sanac) meeting in Secunda, Mpumalanga, which was chaired by Deputy President Kgalema Motlanthe.

The National Strategic Plan has a target to have 3-million people on antiretroviral (ARV) treatment by 2015. South Africa currently has 1.9-million people on treatment.

The plan also aims to eliminate the transmission of HIV infection from mother to child by 2015 and to reduce AIDS-related maternal deaths. The country has in the recent past seen significant changes in the rate of mother-to-child HIV transmission.

Between 2008 and 2012, the rate of mother-to-child HIV transmission dropped from 8% to 2.7%. There was a leap in the percentage of HIV-infected women receiving ARV therapy between 2011 and 2012, from 87.3 % to 99%.

Similarly, 99 % of all infants born to HIV-infected women receive prophylactic ARV medication to reduce the risk of early mother-to-child HIV transmission in the first six weeks.

In this plan “Sanac aims to reduce TB incidence and mortality caused by TB in people living with HIV by 50 % in 2015″, read the statement from the council.

Sanac also approved plans to launch an HIV prevention programme aimed at sex workers. Details of the project were, however, not released with the council saying it would do so closer to the launch.

The National Strategic Plan is one of the many plans the government is implementing. Early, this month, Health Minister Aaron Motsoaledi announced the introduction of fixed-drug combination ARV therapy.

Patients living with both HIV and TB, have started being treated on the new therapy.

Fixed-drug combination therapy is a combination of three crucial antiretroviral medications in one tablet, taken only once a day.

This eliminates the need for patients to take three or more pills at various intervals per day.

19 April 2013

From the Business Day Live

http://www.bdlive.co.za/national/health/2013/04/19/aids-council-adopts-national-strategic-plan-for-hiv-tb

Suspected sex workers leave for Luzira Prison after appearing before Kampala City Council Court in 2003

By New Vision

Uganda has been described as the Pearl of Africa. However, in this beautiful land, there are a number of harmful cultural practices that make it a place no child would want to live in. As the third series ofthe Tumaini Awards is launched, Shami lla Kara explores how Uganda Youth Development Link, a nongovernmental organisation, is helping youth find meaningful ways of earning a living as a means of fighting commercial sexual exploitation of children.

Commercial sexual exploitation of children is an insidious cancer that is stealthily spreading and eating deep into the fabric of our society. Cited in the International Labour Organisation’s (ILO) Worst Forms of Child Labour Convention 1999 (No.182) that ILO member states must eliminate without delay, this practice violates the rights of the sexually exploited children, scarring their psychological, physical and social status, thereby relegating them to sub-human living.

ILO defines commercial sexual exploitation of children as “the exploitation by an adult with respect to a child or an adolescent, female or male, under 18 years; accompanied by a payment in money or in kind to the child or adolescent (male or female) or to one or more third parties.”

According to a 2011 study by the Uganda Youth Development Link (UYDEL), an organisation that is involved in fighting and increasing awareness about this practice, commercial sexual exploitation in Uganda is on the increase, with statistics revealing that there are 18,000 children affected, from 12,000 in 2004.

Another study, carried out by the Jinja Network for the Marginalised Child and Youth in 2011, revealed thatcommercial sexual exploitation in Jinja was rampant, with young girls being exploited by trailer drivers, tourists and businessmen, among other abusers.

The UYDEL report, titled, Commercial Sexual Exploitation of Children in Uganda, further shows that the helpless children, who fall in the 14-17 age bracket, endure sexual exploitation for a pittance and risk their lives to earn between sh2,500 and sh5,000 per client.

This exposes them to a high likelihood of unwanted pregnancies, being beaten by the clients or gang-raped and contracting sexually transmitted diseases that include HIV/AIDS.

According to ILO, victims of this practice include “runaways, children from dysfunctional families, children of sex workers, homeless children, AIDS orphans, migrant children, children from ethnic minorities and out-of-school children.”

In Uganda, the UYDEL 2011 report reveals that children, who did not attend school and were engaged in economic activities such as bartending and working in lodges were also vulnerable to being sexually exploited for money.

The report further discloses that the practice is prevalent in urban areas such as Kampala and it has even infiltrated schools.

It adds that victims of the practice are usually trafficked children, orphans, and children coming from economically underprivileged situations.

What the NGO does
Rescuing children from commercial sexual exploitation is one project under the child rights protection programme of the NGO. The programme also covers child trafficking and child labour.

The NGO is involved in other programmes that include HIV prevention among children and a youth programme; the alcohol and substance abuse programme and the adolescent, sexual and reproductive health programme.

It is also involved in social research and has published several publications covering childrelated topics.

Founded in 1993 by Rogers Kasirye, who is also its executive director, the NGO’s mission is “to empower disadvantaged and vulnerable youth with cognitive life and livelihood skills so as to make them useful citizens of Uganda.”

UYDEL’s areas of operation include Kampala, Mukono, Wakiso, Busia and Kalangala.

It employs 57 personnel that include psychologists, social workers, instructors and artisans.

UYDEL’s target beneficiaries are disadvantaged and vulnerable youth aged between 10 and 30 years found living on the streets, in slums, teenage mothers, youth who have dropped out of school and those from poor families.

The organisation also works with parents and other community members for the wellbeing of the youth. In 2011 alone, UYDEL admitted 1,812 vulnerable youth to its programmes

The programmes are implemented through the NGO’s outreach post in Bwaise and its five drop-in centres, four of which are in Kampala and include, Nakulabye, Nateete, Makindye and Kamwokya, as well as one in Mukono district.

Additionally, UYDEL also has a rehabilitation and vocational centre at Masooli parish in Wakiso district, where youth who have no where to live are given temporary accommodation

The centre also trains the youth in skills that include plumbing, hairdressing, catering, welding and metal fabrication and tailoring.

The NGO further finds field placements for at least six months for the youth.

This approach has supported strong and sustained behavioural change and helped withdraw adolescents and youth who were engaged in child labour and other exploitative activities to find meaningful ways of earning a living

Besides vocational skills training, the youth also access psycho-social support services, counselling services, medical care such as the testing and treatment of sexually transmitted infections and therapy at the centre in Masooli.

Through performance therapy, rehabilitated children are empowered to tell their stories, an initiative that has reached out to over 1,000 youth in eight slum communities.

UYDEL also engages the youth in behavioural change communication sessions, which aim at encouraging sustained behavioural change.

These sessions cover topics such as drug abuse, children’s rights, sexual and reproductive health and life skills. These sessions are also conducted in the communities for youth, who cannot come to the centres through community outreach dialogues.

UYDEL is also involved in advocacy activities that include creating awareness about Article 33 of the United Nations Convention on the Rights of the Child and work with parents, children and communities to support prevention programmes advocating for drug-free environments.

The NGO has, of recent, been included in a pilot campaign by the International Olympic Committee to help fight substance use in youth through sports.

Kisenyi slum in Kampala. Some of UYDEL’s target beneficiaries are those living in slums

7 May 2013

http://www.newvision.co.ug/news/642428-helping-to-heal-wounds-of-sexually-exploited-children.html

By Prosper Agbenyega

More than 120 HIV clinicians, policy makers, and laboratory scientists gathered in Cape Town, South Africa from 18-20 April 2013 at the invitation of the African Society for Laboratory Medicine (ASLM), the World Health Organization’s Regional Office for Africa (WHO-AFRO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Society for AIDS in Africa (SAA), and the Southern African HIV Clinicians Society for a three-day consultation to discuss how best to design and implement effective and sustainable HIV viral load testing programmes in Africa.

Convening under the theme “Viral Load Testing in African HIV Treatment Programmes,” healthcare professionals and stakeholders from more than 20 African Ministries of Health and other global partners developed consensus strategies for strengthening or expanding HIV viral load testing capacity in Africa; attendees also worked to enhance partnerships to support the scale-up of this important diagnostic test and monitoring marker of HIV infection.

“Viral load is the best tool we have for monitoring treatment success and deciding when to switch to new antiretroviral therapy (ART) medications,” said Dr. Gottfried Hirnschall, Director, HIV/AIDS Department, World Health Organization. “To better support people on ART and support the preventive benefits of ART in reducing HIV transmission, improving access to simple, affordable viral load testing in resource-limited settings is a priority for the coming years.”

“Ensuring that people living with HIV have access to safe and accurate monitoring of the virus is a basic human right,” said Michel Sidibé, Executive Director of UNAIDS.  “Testing needs to be simpler, quicker, more cost effective and more widely available, only then will the full benefits of antiretroviral therapy be realised.”

As part of an overall effort to achieve an AIDS-free generation, many countries in Africa have started to adopt and implement HIV viral load testing programmes. A number of challenges exist which limit test access and cost-effectiveness. This consultative meeting aimed to:

• Develop strategies and recommendations for adopting and implementing HIV viral load testing policy, in consideration of World Health Organization guidelines;

• Review operational, technical and financial challenges to expanding access to HIV viral load testing in Africa, especially in difficult to reach areas;

• Discuss strategies for development of technical skills and technology transfer; and,

• Develop strategies to utilise existing capacity of and implement future point-of-care HIV viral load technologies.

Speakers and attendees included representatives from African Ministries of Health, the South African National Health Laboratory Service, World Health Organization, UNAIDS, United States Centers for Disease Control and Prevention, government global health programmes, private organisations and industry.

“As African health programmes continue to achieve marked success concerning patient outcomes, mature laboratory programmes remain integral to this achievement. ASLM is the first pan-African organisation committed exclusively to advancing and guiding laboratory medicine,” says Dr. Tsehaynesh Messele, ASLM Chief Executive Officer. “Laboratory services play a pivotal role in maintaining strong, healthy communities, part of which is monitoring HIV viral load in patients.”

4 May 2013

http://www.spyghana.com/partners-to-discuss-hiv-viral-load-testing-programs-in-africa/

After the March 2013 launch of AAI’s Country Coordinating Mechanisms (CCMs) Community Consultation Report entitled “Who is really affecting the Global Fund decision making process?” AAI has begun conducting advocacy around the findings. The objective is to use the research as an accountability tool, acting as a best-practice and gaps analysis evidence base for improving the meaningful participation processes of women, girls and those marginalized by their sexual orientation in Global Fund processes.

Download the full report: Who is really affecting the Global Fund decision making processes? A Community Consultation Report

Download the survey report: Who is really affecting the Global Fund decision making processes? A Quantitative Analysis of CCMs

Download the media release: AIDS Accountability International on the Global Fund

To achieve this, AAI conducted its Global Fund Advocacy Week at the Global Fund Secretariat in Geneva, Switzerland, from 15-19 April 2013, since engaging Fund Portfolio Managers and Senior Technical Advisors on gender and key populations is critical for holding both the CCMs and the Global Fund Secretariat accountable for their obligations to marginalized populations. AAI also endeavoured to connect with other partners in Geneva, such as the World Young Women’s Christian Association (World YWCA), the International Labour Organization (ILO) along with funding partners and independent stakeholders.

On Monday 15 April 2013, AAI began its Global Fund Advocacy Week in Geneva by meeting with Nyaradzayi Gumbonzvanda (General Secretary) and Hendrica Okondo (Global Programme Manager SRHR & HIV Focal Point for Africa) at the World Young Women’s Christian Association (World YWCA). The discussion focused on reducing the distance for dialogue between young girls and policy makers, creating spaces of “conversational accountability” and “intergenerational dialogues” so that young girls can have the opportunity to engage with decision makers, but in less technical forums. Leadership was also a topic of strategic thinking, with AAI and the YWCA brainstorming around how to redefine leadership so that it does not rest on the pillars of education or income.

The following day, AAI met with a team of senior technical specialists at the Global Fund Secretariat. Speaking with Linda Mafu (Head, Political and Civil Society Department), Sara Davis (Senior Specialist in Human Rights and Equity), Motoko Seko (Gender and Human Rights Specialist) and Mauro Guarinieri (Senior Advisor, Community Systems Strengthening and Civil Society), AAI pushed for greater accountability towards Human Rights in Global Fund processes. It was agreed during the meeting that viewing human rights through a public health lens can often be highly effective in certain contexts where the rights and women, girls and LGBT people can be politically and culturally sensitive. This supports the research findings in AAI’s CCM Report. AAI and the Global Fund also discussed the new CCM guidelines (2010) which say that CCMs should demonstrate effort to include key affected populations in the country dialogue process. In terms of the way forward, it was raised that Fund Portfolio Managers might benefit from capacity building on how to engage better with civil society outside of the CCM, as well as on human rights and key populations issues.

Continuing with Global Fund Advocacy Week, AAI met with two Fund Portfolio Managers (FPMs), Richard Cunliffe (Botswana, Swaziland) and Viviane Hughes-Lanier (Niger). At these two meetings, AAI consulted with the FPMs about how best to strengthen Africa’s CCMs through improved participation of marginalized groups. The result was a recommendation from the Secretariat to build the capacity of civil society to become principal or sub-recipients, train key populations CCM members on how to influence a meeting, and train the CCM Chairs and Co-Chairs on how to run a meeting that includes discussions of strategic thinking around human rights considerations.

At the end of the week, solid plans had been made to move forward with the project in a manner that continues to involve the Secretariat in Geneva. This way, AAI can increase its impact in pushing for greater accountability to women, girls and SOGI groups from both the CCMs in country, and the FPMs and Technical Specialists at the Global Fund in Geneva.

Goodluck Jonathan, President of Nigeria

23 April 2013

ABUJA - Nigeria’s President, Goodluck Jonathan, agreed to help lead the Global Fund’s efforts to raise funds this year, a critical role in the partnership to fight AIDS, tuberculosis and malaria all over the world.

President Jonathan met with Mark Dybul, Executive Director of the Global Fund, on Monday to discuss joint efforts to control these deadly infectious diseases in Africa’s most populous nation and globally.

Dr. Dybul praised President Jonathan’s effective leadership and personal commitment to expanding health services, embodied by Nigeria’s “Save One Million Lives” initiative that is aiming to dramatically increase access to basic quality health services, particularly for women and children.

President Jonathan accepted an invitation be a Co-Chair in this year’s replenishment efforts by the Global Fund. Other Co-Chairs include UN Secretary-General Ban Ki-moon and heads of state from developed countries, emerging economies and the private sector.

“Working together, we can make tremendous gains, said Dr. Dybul. “With the existing science, our understanding of the epidemiology and our collective experience in combating the diseases, we now have an opportunity to control them. If we do not, the long-term costs will be incalculable.

During his first visit to Nigeria as Executive Director of the Global Fund, Dr. Dybul also met with the Minister of Health, Prof. Chukwu Onyebuchi and Minister of State for Health, Dr. Muhammad Pate, and other key stakeholders, partners and implementers to discuss opportunities to further strengthen collaboration.

Mr. Aig-Imoukhuede, Chairman of Friends Africa, said: “The upcoming replenishment of the Global Fund is its most critical replenishment and ought to be given the highest levels of support for the fight against these diseases to be won.”

Dr. Dybul announced that the Global Fund is providing up to US$ 288 million in additional funding to help accelerate programs to prevent and treat HIV and malaria in Nigeria. This new funding is being made available under a new funding model, and Nigeria is one of 47 countries accessing new funding through renewals, grant extensions and redesigned programs in 2013.  The Global Fund’s latest HIV grants are targeting pregnant women and “most-at-risk” populations such as women and girls, sex workers, people who use drugs, men who have sex with men, while the TB grants support expansion of diagnosis and treatment capacity including treatment of multidrug-resistant TB.

Malaria grants are aiming to achieve nationwide coverage of mosquito nets through mass campaigns and routine distribution, while at the same time increasing availability of antimalarial medicines and diagnostic tests.

Despite promising advances in recent years, such as declining AIDS and TB mortality and a sharp increase in the use of insecticide-treated nets, Nigeria faces serious health challenges. Over the last 12 months, Nigeria and the Global Fund signed agreements in worth a total of US$ 560 million to support programs that will help significantly expand prevention, diagnosis and treatment of the three diseases.

Dr. Dybul appealed to President Jonathan to expand domestic investment in health even further.

Nigeria has the second-largest number of people living with HIV in the world after South Africa. But only 30 percent of those needing treatment are on antiretroviral therapy and only 16 percent of pregnant HIV-positive mothers are getting prophylactic treatment to prevent them from passing on the virus to their babies.

The country also has the second-highest child and maternal mortality in the world, in absolute numbers, and accounts for nearly one-third of deaths from malaria globally. While TB mortality has fallen significantly since 2003, case detection rates are still among the lowest in the world.

For more information, please contact:

ANDREW HURST
Head of Media and Translations
Mobile: +41795616807
E-mail: andrew.hurst@theglobalfund.org

26 April 2013

Global Fund News Release

http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-04-23_President_of_Nigeria_Joins_Global_Fund_Efforts_to_Broaden_Fight_Against_HIV,_TB_and_Malaria/

25 April 2013

AAI has distilled the key messages of the Civil Society African Common Position Paper on ICPD into 12 brief points for easy reading.

We will continue seeking endorsements in the coming weeks and have already had over 100 CSOs in Africa and worldwide sign on!

Join us and give more power to the people!

SIGN ON to endorse this document here

1. Human Rights

The document is fundamentally based on human rights. This means that the main objective of all development policies and programmes and their implementation must be to respect, protect and fulfil human rights for all.

1.1.      Demography and population growth: The document clearly addresses the potential abuses of demographic and population growth policies and strategies that ignore the human rights of individuals. It also demands that all population growth and structure, and demographic work is approached with a human rights and gender responsive lens. It requests guarantees that policies to address high fertility and rapid population growth will focus on enlarging, not restricting, individual choices and opportunities. Clear policy guidelines must be developed and implemented so as to ensure that human rights and gender responsive lens is used through to clinic level so that abuse and misinterpretation does not occur.

1.2.      All vulnerable people included: The document identifies vulnerable and key affected populations that require better inclusion and more focussed policies, programming and implementation in order to realize their full socio-economic and civil and political rights and freedoms. It acknowledges the role of both the vulnerable and the role of the already empowered and that they need to engage in promoting equality, equity and empowerment for all.

1.3.      Duty-bearers and rights-holders: Both duty-bearers and rights-holders are identified throughout the document as a means to better identify the needs and entitlements of the former, and the obligations and duties of the latter. It also speaks to where capacity is lacking in order to empower the latter to hold the former accountable.

2. Accountability and Transparency

The document highlights the need for accountability which can be gained from collective transparency, open dialogue and greater focus on implementation and action with the attainment of human rights for all as the ultimate goal.

2.1.      Reporting: To report in a timely manner, accurately and transparently on progress made. To ensure that monitoring and accountability mechanisms adopt a systemic and sustained human rights approach towards the implementation of the ICPD, Maputo Plan of Action (MPOA) and other relevant commitments;

2.2.      Quality of data: To improve the quality of reporting by improving data, increasing quality and quantity of responses in reporting documents, using a collaborative process with civil society for the completion of reports, and ensuring appropriately disaggregated data is available and included in reporting.

2.3.      Dialogue between government and Civil Society Organisations (CSOs): Use open dialogue between government, civil society and policy organs, to create more discussion around current status, national responses and challenges surrounding the attainment of universal access to sexual and reproductive health and rights (SRHR) and health services on the continent.

3. Focus on Implementation

The document highlights the need for a “less talk, more action” stance. This includes a focus on implementation of budget, human resource development and improved national ownership rather than policy and/or commitment development.

3.1.      Budget allocation and spending: To boost funding for health, especially SRHR, by implementing the commitment made in Abuja to dedicate 15% of national budget to health. In addition, the document calls for implementation of the MPOA commitment to allocate 15% of health budget to family planning commodities. It is important to also identify alternative funding sources. There is a need to improve monitoring and evaluation and financial controls of existing budgets and expenditures;

3.2.      Focus on African capacity: To allocate budget and implement capacity building for health systems strengthening through improved human resources. This is for health staff as well as national institutions, community systems and Ministry of Health staff. It is necessary to mount evidence-informed and rights-based responses, whilst also working on retaining existing staff, improving the existing quality of training and promoting South-South cooperation.

3.3.      Leadership and national ownership: To commit to an all-inclusive and accountable leadership that ensures integration of SRHR into national development instruments. Leaders must also create space for national debate on priorities, strategic investments, social protection and legal measures. Leaders are required to create and adhere to good governance practices in all aspects of health systems strengthening.

4. Future forward

The document highlights the possibilities available to us as well as the need for innovative, modern and cutting edge knowledge, attitudes, decisions and strategies to be used in strengthening African health systems.

4.1.      Technology: Use of innovative technologies, up to date knowledge, scientific and evidence-based decision-making to ensure that health systems are modern, sustainable, and intelligent. Decisions must be based on cutting edge philosophies and forward-looking thinking. We should be including newly developed yet proven safe services and commodities.

4.2.      Quality and acceptability of services and commodities: ensure that sexual and reproductive health services and commodities are high-quality, available, accessible, and acceptable to all people. Ensure that the widest range of services and commodities and innovative technologies are provided as part of the modern health system.

4.3.      Protect the population’s human rights: Prioritise human rights in sexual and reproductive health programmes by guaranteeing that services are designed to respond to individual’s health needs. This includes overcoming barriers faced by marginalized groups. This must be done through service provision that is free from stigma, coercion, discrimination and violence, based on full and informed consent, and that affirms the right to pleasure and thus looks to an African future for health systems based on human rights.

For more information, the full Civil Society African Common Position Paper and contact details click here

6.    Key populations

This section provides recommendations that addresses key matters that affect gender equality, equity and empowerment for all

1. Women,
2. Persons with disabilities,
3. Youth,
4. Lesbian, Gay, Bisexual, Transgender and Intersex Persons (LGBTI),
5. Persons living with HIV (PLHIV),
6. Older persons,
7. Orphans, and
8. Migrant populations.

6.1.      Gender Equality, Equity and Empowerment of all women

6.1.1.   Ensure human rights based approach and that women’s and girl’s perspectives and rights are observed in all national SRHR policies and laws, and that all legal and institutional barriers to women realising full equality, equity and empowerment are removed as a matter of urgency,

6.1.2.   To advocate for comprehensive societal affirmative action that promotes gender equity and equality in all spheres of life, including in the labour market. This includes addressing all policies that do not favour the ability of women to engage successfully in socio-economic activities, as well as committing to and financing the economic, political and social empowerment of women and girls through deliberate national programs which also include increasing women’s access to capital, land and credit facilities,

6.1.3.   Continuous development and implementation of effective monitoring and evaluation mechanisms that aimed at evaluating progress toward national gender programmes, including but not limited to the improvement of data quality collection and analysis.

6.1.4.   Ensure that there is creation and implementation of the legal and institutional framework that protects the rights of woman and young girls from harmful traditional practices such as inability to inherit and Female Genital Mutilation (FGM).

6.1.5.   Commit to addressing the definition of gender which is currently limited to the binary of male and female which excludes different identities. Therefore, there must be the promotion of a comprehensive and all inclusive definition so as to support the equality of all women regardless of sexual orientation or gender identity,

6.1.6.   Create platforms for continuous, comprehensive, consultative, capacity building for all stakeholders including Civil Society Organisations (CSOs) on gender and its role within SRHR,

6.1.7.   Provide quality education, including comprehensive sexuality and life skills education at early levels for all children to promote empowerment of both girls and boys as a means to promoting equality, equity and empowerment and ensuring boys and men also play a role in realising equality for women,

6.1.8.   Expand decision-making opportunities for women by ensuring their meaningful participation in all stages of design, monitoring and implementation of sexual and reproductive rights policies and programs at national, regional and international levels.

6.2.      Persons with Disabilities

6.2.1.   Ensure the development, implementation and financing of policy and strategies that eradicate all discriminatory practices against persons with disabilities and protect the rights of persons living with disabilities;

6.2.2.   Meaningful engagement of persons with disabilities at policy and implementation level in order to develop non-discriminatory and comprehensive programs that are inclusive of their SRHR needs;

6.2.3.   Create deliberate policy and implementation plans that address the sexual and reproductive health needs of persons living with disabilities and ensure universal access to accessible, acceptable, affordable and quality SRHR services, information and commodities whilst ensuring respect for persons with disabilities privacy and confidentiality in accessing services, and their capacity to make free and informed choices regarding their sexual and reproductive lives from childhood to old age in all their diversity;

6.2.4.   Continuous development and implementation of effective monitoring and evaluation mechanisms that aimed at evaluating progress toward national gender programmes, including but not limited to the improvement of data quality collection and analysis;

6.2.5.   Embark on awareness campaign programmes to dispel myths and misconceptions about the sexual and reproductive needs of people with disabilities and ensure that persons living with disabilities also enjoy healthy and fulfilling sexual lives;

6.2.6.   Ensure the empowerment of persons living with disabilities by creating opportunities for economic development and self- reliance. Provide more possibilities for employment, credit facilities and land;

6.2.7.   Create strategies that ensure the protection of women and girls living with disabilities against intimate partner violence and sexual violence;

6.2.8.   Engage private and public structures to ensure that implementation of the regulations on the rights of persons with disabilities are fully adhered to;

6.2.9.   Train health care workers on disability related health care, including service provision that is free from stigma, coercion, discrimination and violence, based on full and informed consent, and that affirms the right to pleasure.

6.3.      Youth (including pre-adolescents)

6.3.1.   Ensure that all aspects of the Convention on the Rights of the Child are recognised and implemented including the protection from child marriage and other forms of harmful practices as well as promote and implement laws, policies and programs that eliminate harmful practices such as early and forced marriage, rape, sexual and gender based violence, female genital mutilation, honor killings, and all other forms of violence against adolescents and youth;

6.3.2.   Ensure that investments in health (including sexual and reproductive health), jobs, education and skills in youth development are made to position Africa to reap the rewards from the imminent demographic dividend;

6.3.3.   Increase empirical evidence on how to address youth and pre-adolescent issues by strengthening research in academic institutions and greater inclusion of youth in the design, monitoring and implementation of policy, programming and implementation;

6.3.4.   Ensure that cultural and religious barriers such as parental and spousal consent, and early and forced marriages, should never prevent access to family planning, safe and legal abortion, and other reproductive health services – recognizing that young people have autonomy over their own bodies, pleasures, and desires.

6.3.5.   Provide quality education, including comprehensive sexuality and life skills education at early levels for all children to promote empowerment of both girls and boys as a means to promoting equality, equity and empowerment and ensuring boys also play a role in realising equality for girls; as well as remove any and all barriers to accessing quality education and ensure recognition, strengthening and utilisation of ICT in adolescents’ and youth  development;

6.3.6.   Create and sustain comprehensive, objective, and accurate sexuality education and information that is accessible and affirming for all children and youth in and out of schools, that includes but is not limited to the promotion of sexual and reproductive rights, gender equality, self-empowerment, knowledge of the body, bodily integrity and autonomy, and relationship skills development; are free of gender stereotypes, discrimination, and stigma; and are respectful of children’s and adolescents’ evolving capacities to make choices about their sexual and reproductive lives.

6.3.7.   Prioritize sexual and reproductive rights issues in health systems strengthening and development programs so that integrated, high-quality services are available, accessible, and acceptable to all young people, particularly those most underserved. These services include but are not limited to comprehensive information on sexuality and contraception services and supplies (including emergency contraception, post exposure prophylaxis, male and female condoms); pregnancy care (antenatal and post natal care, skilled birth attendance, referral systems, and emergency obstetric care); safe abortion services and post-abortion care; access to assisted reproductive technologies; prevention, treatment, and care of sexually transmitted infections and HIV; prevention, treatment and care of reproductive cancers.

6.3.8.   Greater recognition on the need for psychosocial support for adolescents and youth especially those in conflict areas;

6.3.9.   Recognise and provide for the increased need for provision of SRH services and commodities in conflict and post conflict areas, where education of sexual and reproductive rights in post conflict regions must be aimed at reducing gender-based violence;

6.3.10.    Protect young people’s human rights in sexual and reproductive health programs by guaranteeing that services are designed to respond to individual’s health needs and overcome barriers faced by marginalized groups, including through service provision that is free from stigma, coercion, discrimination and violence, based on full and informed consent, and that affirms the right to pleasure.

6.3.11.    Ensure that programs show respect for adolescents’ and young peoples’ privacy and confidentiality in accessing services, and their capacity to make free and informed choices regarding their sexual and reproductive lives including parenthood, from childhood to old age in all their diversity; and pay special attention to marginalized groups of adolescents and young people, including those with disabilities, living with HIV and AIDS, and of all sexual orientations and gender identities as well as those in conflict areas;

6.3.12.    Ensure routine monitoring of potential disparities in universal access to sexual and reproductive health information and services for adolescent and young people through regular collection and analysis of quality data;

6.3.13.    Decriminalize abortion, and create and implement policies and programs that ensure young women have access to safe and legal abortion, pre- and post-abortion services, without mandatory waiting periods, requirements for parental and spousal notification and/or consent or age of consent.

6.4.      Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) persons

6.4.1.   Ensure human rights based approach and that lesbian, gay, bisexual, transgender and intersex persons perspectives and rights are observed in all national SRHR policies and laws, and that all legal and institutional barriers to LGBTI realising full equality, equity and empowerment are removed as a matter of urgency;

6.4.2.   Ensure that the right to health, especially SRHR, is made available to all people regardless of sexual orientation or gender identity and that services are provided by sensitized and trained health care workers who provide health care that is free from stigma, coercion, discrimination and violence, based on full and informed consent, and that affirms the right to pleasure and privacy and confidentiality;

6.4.3.   Increase empirical evidence on how to address LGBTI specific issues by strengthening research in academic institutions and greater inclusion of LGBTI in the design, monitoring and implementation of policy, programming and implementation;

6.4.4.   Create deliberate policy and implementation plans that address the needs of sexual minorities as a necessary element to ensure universal access to quality SRHR services and commodities that are affordable, accessible and acceptable;

6.4.5.   Ensure that there are national strategies and legislation to reduce stigma and discrimination toward LGBTI, and ensure the enforcement of these laws in accessing services and information;

6.4.6.   Continuous development and implementation of effective monitoring and evaluation mechanisms that aimed at evaluating progress toward programmes aimed at providing human rights based equality, equity and empowerment of all people regardless of their sexual orientation or gender identity, including but not limited to the improvement of data quality collection and analysis.

6.5.      Persons living with HIV (PLHIV)

6.5.1.   Ensure human rights based approach and that perspectives and rights of people living with HIV are observed in all national SRHR policies and laws, and that all legal and institutional barriers to PLHIV realising full equality, equity and empowerment are removed as a matter of urgency;

6.5.2.   Ensure that the right to health, especially SRHR, is made available to all people living with HIV and that services are provided by sensitized and trained health care workers who provide health care that is free from stigma, coercion, discrimination and violence, based on full and informed consent, and that affirms the right to pleasure and privacy and confidentiality;

6.5.3.   Ensure routine monitoring of potential disparities in universal access to sexual and reproductive health information and services for people living with HIV through regular collection and analysis of quality data;

6.5.4.   Create an enabling legal environment that will encourage pregnant women to under-go HIV testing, provide treatment care and support and ensure availability of antiretroviral therapy for all HIV pregnant women, especially those in rural areas;

6.5.5.   Urgently put in place policy, programming and implementation strategies to ensure prevention of mother to child transmission;

6.5.6.   Address HIV-related stigma and discrimination through education and awareness campaign programme;

6.5.7.   Promote voluntary HIV counselling and testing in all public hospitals, including primary health care services;

6.5.8.   Ensure that HIV prevention services form part of family planning services;

6.5.9.   Allocate funds targeted to HIV that protect and empower young people, especially young women. In particular, guarantee funding for the provision of comprehensive sexual and reproductive health services that include comprehensive sexuality education; prevention, counselling, voluntary testing, treatment and care of HIV, as well as other sexually transmitted infections and reproductive cancers; and universal access to female and male condoms, microbicides and other female initiated prevention technologies and vaccines

6.6.      Other especially vulnerable persons, including older persons, orphans and vulnerable children and refugees, asylum seekers and internally displaced persons and migrant populations.

6.6.1.   Ensure human rights based approach and that perspectives and rights of vulnerable people are observed in all national SRHR policies and laws, and that all legal and institutional barriers to vulnerable people realising full equality, equity and empowerment are removed as a matter of urgency;

6.6.2.   Ensure that the right to health, especially SRHR, is made available to all vulnerable people and that services are provided by sensitized and trained health care workers who provide health care that is free from stigma, coercion, discrimination and violence, based on full and informed consent, and that affirms the right to pleasure and privacy and confidentiality;

6.6.3.   Ensure routine monitoring of potential disparities in universal access to sexual and reproductive health information and services for vulnrable people through regular collection and analysis of quality data;

6.6.4.   Create awareness of the SRHR needs of older persons and develop policies and programmes that respect the sexual and reproductive health needs of older persons and include them in the process of decision-making as well as train health care providers to provide sexual and reproductive health services that are appropriate and acceptable to the needs of older persons;

6.6.5.   Create national structures and laws that adequately evaluate andaddress pension payments and other support to older persons, especially those who are abandoned by their families and communities, and streamline the payment of pensions to retirees;

6.6.6.   Assist African States interested in establishing support structures for abandoned old persons especially those who are also victims of discrimination (accused of witchcraft or other).

6.6.7.   Create and support existing systems and structures which care for orphans and vulnerable children (OVC), ensuring quality services, education and other provisions are made to ensure their human rights are respected;

6.6.8.   Ensure the provision of AAAQ SRH services, information and commodities in a timely manner including mental health treatment, care and support for all orphans and vulnerable children;

6.6.9.   Facilitate the enactment and implementation of the Convention on the Rights of the Child in all countries to protect children and young people, especially orphans, from all forms of violence and harmful practices including early and forced marriages.

6.6.10.    Ensure the provision of comprehensive sexuality education for orphans that promote sexual and reproductive rights, gender equality, self-empowerment, knowledge of the body, bodily integrity and autonomy, and relationship skills development; are free of gender stereotypes discrimination, and stigma; and are respectful of children’s and adolescents’ evolving capacities to make choices about their sexual and reproductive lives;

6.6.11.    Guarantee universal access to comprehensive essential sexual and reproductive health services by providing sufficient and sustainable financing to achieve the training, deployment, and retention of necessary health workers; ensure equitable access and good quality services;

6.6.12.    Ensure universal access to free (eliminating all forms of levies & user fees at all levels), quality, and comprehensive education at all levels in a safe and participatory environment.

6.6.13.    Commit to researching and better understanding the health needs and SRHR needs of refugees, asylum seekers and internally displaced persons and migrant populations and ensure their inclusion in the development of policies, programming and implementation of health care.

6.6.14.    Ensure that there are national strategies and legislation to reduce stigma and discrimination toward refugees, asylum seekers and internally displaced persons and migrant populations, and ensure the enforcement of these laws in accessing services and information.

To download the full document click here: AAI AUC Ford Civil Society African Common Position Paper on ICPD 2013 April

5. Health morbidity & mortality

5.1. Women’s health and safe motherhood

5.1.1. Renew commitment to reducing maternal mortality and morbidity as a matter of urgency and allocating financial resources to ensure the development and implementation of policy and clear policy guidelines that guarantee universal access to the provision of family planning and contraceptive services , with free or subsidized care for those in need and those most marginalised;

5.1.2. Understand and demonstrate that safe motherhood is a human rights issue and as such needs to be positioned as a key concern in national dialogue on sexual and reproductive health and requires a strong rights approach at all levels of the ministry of health;

5.1.3. Ensure the development and implementation of policy and clear policy guidelines that guarantee universal access to an integrated service package, including but not limited to: mental health care; the provision of SRH services and commodities, improved ante-natal care, and response and care for obstetric emergencies;

5.1.4. Incorporate evidence-based clinical protocols that improve the referral system, strengthen transport and communication networks, promote community mobilization, build bridges between health care providers and social networks, improving the clinical and communication skills of providers at the health care level, improving access to skilled health providers, increasing access to referral services, and prevention of unwanted pregnancy and care of post abortion complications;

5.1.5. Educate and empower women and men to present at health care provider for pre-natal care at an earlier stage of pregnancy and more regularly, as well as to adhere to medical advice to ensure a healthy pregnancy;

5.1.6. Provide, without fear of prosecution, criminalisation, discrimination or intimidation, quality and prompt post abortion care and counselling to women who have undergone unlicensed, incomplete and/or illegal abortions and who require medical attention;

5.1.7. Remove all obstacles, including payment of fees, for women seeking medical attention during pregnancy and ensure free or subsidized care for those in need and those most marginalised especially rural based women;

5.1.8. Research and better understand the role and knowledge of traditional birth attendants and traditional or indigenous medicine and ensure that where applicable the benefits can be maximised and the dangers minimised.

5.2. Child survival and health

5.2.1. Mobilize political leadership to end preventable child deaths as a matter of urgency;

5.2.2. Implement evidence based country plans that sharpen government led action plans, track and sustain progress against 5 year milestones and align development support with national strategies;

5.2.3. Build on mechanisms to monitor and report progress, compile and disseminate annual progress reports, and promote transparency and accountability through regional and global forums;

5.2.4. Ensure the availability and accessibility of immunization services for all children;

5.2.5. Build capacity of parents and caregivers on health issues for children and babies including but not limited to when to seek medical attention, which foods are most nutritious, needs of sero-discordant families, the strengths and weaknesses of breast and bottle feeding, and accessing uncontaminated water for drinking and protecting children from infectious diseases like malaria and pneumonia with vaccines, bed nets, and antibiotics.

5.2.6. Research and better understand the role and knowledge of traditional or indigenous medicine for child survival and health and ensure that where applicable the benefits can be maximised and the dangers minimised.

5.2.7. Provide accessible, affordable, acceptable quality health services and information and support, including mental health services to HIV positive mothers and fathers before, during and after the birth process to ensure the prevention of mother to child transmission of HIV.

5.2.8. Urgently put in place policy, programming and implementation strategies to ensure prevention of mother to child transmission, especially by designing and implementing PMTCT programmes that are directed at community level in terms of applicability, language, local traditions and misconceptions;

5.2.9. Create an enabling legal environment that will encourage pregnant women to under-go HIV testing, provide treatment care and support and ensure availability of antiretroviral therapy for all HIV pregnant women, especially those in rural areas;

5.3. Non-Communicable Diseases

5.3.1. Improve information and research on non-communicable diseases (NCDS) and develop policies and programmes that are up to date and will address the challenges posed by non-communicable disease;

5.3.2. Increase public awareness and education of non-communicable diseases, including life-style, environmental and occupational related NCDs, such as Type 2 diabetes, hypertension (high blood pressure), and cancer and to implement campaigns to use prevention methods as much as possible.

5.3.3. Ensure the better screening and proper management and control of non-communicable diseases by providing timely and AAAQ diagnosis, treatment and information;

5.3.4. Equip health care centres and train health care workers to provide services for complications arising from non-communicable diseases;

5.3.5. Allocate appropriate resources towards address the challenges pose by non-communicable diseases;

5.3.6. Create awareness among people especially those in rural communities on environmental cleanliness.

To download the full document click here: AAI AUC Ford Civil Society African Common Position Paper on ICPD 2013 April